What is That Red Bottle? Caries Detector Dye!

Caries detector dye (CDD) was pioneered nearly 40 years ago by researcher Takao Fusayama at Tokyo Medical and Dental University. Today it is rarely seen in dental practices, but commonly used in dental schools as “training wheels” for students learning to treat caries. At the Alleman Center, we consider CDD essential for every restoration because it allows caries treatment to be consistent between different patients and different doctors. Without consistent caries treatment, you can’t have predictable dental outcomes.

What is caries detector dye?

Caries detector dye is a red dye used to identify caries (decay) in a tooth. The red dye detects the presence of caries by becoming trapped in dentin (the majority of what your tooth is made of) that has been broken down by the bacteria, specifically denatured collagen. Depending on the severity, the stain will range from dark red to light pink. If you ever look at Alleman Center patient cases and see red or pink portions of the tooth, that is dentin stained by CDD.

Caries detector dye (CDD) looks pink when applied to the tooth. In this case by Dr. Davey Alleman, DMD, the entire tooth is covered to see what portions are carious (decayed).

How is caries detector dye used in restorative dentistry?

Removing caries completely where your restoration will be bonded helps your tooth stay sealed, symptom-free and supported. CDD is applied to the tooth, and stained portions are removed with precise measurements to protect your tooth’s nerve, also called the pulp. CDD application will be repeated until this area around the pulp is free from caries (no stain) and ready to bond to your restoration.

Pink stain in the center of this tooth is from caries detector dye (CDD). This stained dentin is too close to the pulp (the tooth’s nerve) to be safely removed. All other stain has been removed, so this tooth is ready for bonding. Case by Dr. Davey Alleman, DMD.

How does caries detector dye make dentistry more predictable?

CDD shows exactly what portions of the tooth are carious and which are not because the dye becomes trapped in collagen that has become denatured from the presence of caries. Traditional practices encourage dentists to use an instrument to push on areas of the tooth to see if they feel soft (carious) or not (sound). This is subjective; every dentist would treat the same tooth in a different way. A study conducted in 1985 found that 59% of practitioners left decay behind when they used this tactile approach. By using CDD, you can make caries treatment objective, meaning it will be consistent in every restoration with every dentist. 

Why don’t all dentists use caries detector dye?

CDD is used to teach dental students, who are then encouraged to use a tactile approach for caries treatment when they feel they understand what is carious and what is not. Using CDD is often considered a crutch for less skilled dentists, but this is not the case. CDD adds essential predictability to a restoration that can save patients and dentists the frustration of restorations that fail or remain sensitive.

Some dentists also believe that advocates for CDD recommend removing all stained dentin. This is not our recommendation at the Alleman Center, nor is it the recommendation among researchers of CDD use. While early research into CDD included protocols for removing all stained dentin, that guidance changed shortly after. CDD-stained dentin should be removed around the pulp, while using precise measurements to avoid drilling into the pulp chamber. Stained tooth structure too near the pulp is sealed with the next steps in the restorative process, which causes any remaining bacteria near the pulp to go dormant as part of the tooth’s natural immune response.

While there are many misconceptions around CDD, we use it in every restoration at the Alleman Center because we know it is best for our patients. Patients want restorations that stay bonded, resolve symptoms and protect their tooth’s future health. This little red bottle helps us offer that to every patient we see.

You might still have questions.

Where can I see how CDD is used? VIsit our Examples of Work page to see how CDD is used as part of a restoration, or visit Dr. Alleman’s instagram @davey_alleman_dmd.

I have questions about my treatment options. Who can I talk to before scheduling an appointment? Our Patient Care Coordinator, Sheila, will be happy to answer any questions about your treatment options because you schedule an appointment. Contact her at office@allemancenter.com or (801) 717-9860.

We’ll write about these topics and more in future blog posts, or we’re here to talk about the work we do any time. Reach out at office@allemancenter.com or (801) 717-9860 any time, or ask Dr. Alleman at your next appointment.